Gastric/Esophagus Cancer I Case1: Her2 I 2:GE Junction I 3: Early gastric CA I 4:Early Esophageal CA скачать в хорошем качестве

Gastric/Esophagus Cancer I Case1: Her2 I 2:GE Junction I 3: Early gastric CA I 4:Early Esophageal CA

CASE 1. HER2 is a proto-oncogene encoded by ERBB2 on chromosome 17, also a member of the HER family. The intracellular domain of HER2, is responsible for extracellular signal transmission to initiate cellular signaling pathways leading to cell proliferation, cell survival, angiogenesis, migration, and invasion. HER2-positive status (protein overexpression and/or gene amplification) has been identified in several carcinomas, especially in breast cancer which plays a vital role in deterring prognosis and treatment plan. On the other hand, in gastric cancer, the reported level of HER2 overexpression and amplification varies widely from 7%–27% and the prognostic value of HER2 status remains controversial. It is Intestinal-type disease showed a higher rate of HER2 protein expression and gene amplification than diffuse type. The overexpression rates of HER2 in phase III-IV disease were significantly higher than that in phase I-II disease Reference: The diverse signaling network of EGFR, HER2, HER3 and HER4 tyrosine kinase receptors and the consequences for therapeutic approaches. Zaczek A, Brandt B, Bielawski KP. Histol Histopathol. 2005 Jul; 20(3):1005-15 Zhang XL, Yang YS, Xu DP, Qu JH, Guo MZ, Gong Y, Huang J. Comparative study on overexpression of HER2/neu and HER3 in gastric cancer. World J Surg. 2009 Oct;33(10):2112-8. doi: 10.1007/s00268-009-0142-z. PMID: 19636613. CASE 2. This patient has a adenocarcinoma of the GEJ are often treated in the same way esophageal adenocarcinoma. T4a esophageal lesions include involvement of the pericardium, pleura and diaphragm can still be considered for surgical resection, but neoadjunvat treatments are recommended. the options are of either neoadjuvant chemoradiation (Carboplatin + Paclitaxel or Cisplatin + 5-FU) which is the preferred option as per NCCN guidelines. The other option is to treat with neoadjuvant chemotherapy such as Cisplatin/5-FU or FLOT (5-FU, Leucovorin, Oxaliplatin and Docetaxel) chemotherapy followed by surgery which is then followed by adjuvant chemotherapy. Patients with cT4b disease Involvement of heart, great vessels (aorta), trachea, vertebral body, or adjacent organs (lung, pancreas etc.) are not deemed to be surgical candidates and should be offered Definitive chemoradiation (RT, 50-50.4 Gy + concurrent chemotherapy). Reference: http://www.nccn.org/professionals/phy... CASE 3. Patients with gastric cancer who did not received neoadjuvant chemotherapy or chemoradiation and are subsequently found to have either pT3, pT4 any N or Any pT, N+ should receive adjuvant therapy. recommended if less than a D2 dissection is achieved then the recommended adjuvant treatment would be Fluoropyrimidine (5-FU or Capecitabine) then 5-FU based chemoradiation then Fluoropyrimidine. On the other hand, Chemotherapy is the recommended adjuvant modality patients who have undergone primary D2 Lymph node dissection. The chemotherapy of choice The Capecitabine and Oxaliplatin as per the CLASSIC STUDY which reported an improvement in DFS from 59% to 64% in the chemo+ surgery vs surgery only groups. Reference: Bang YJ. Lancet 2012. Adjuvant capecitabine and oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): a phase 3 open-label, randomised controlled trial. Lancet 2012;379 (9813):315-21 CASE 4. The Siewert-Stein classification of esophageal adenocarcinoma classes these tumors according to their relationship to anatomical landmarks. Siewert tumor type should be assessed in all patients with adenocarcinoma involving the EGJ. Siewert Type I: Adenocarcinoma of the lower esophagus with the epicenter located within 1 cm to 5 cm above the anatomic EGJ Siewert Type II: True carcinoma of the cardia at the EGJ, with the tumor epicenter within 1 cm above and 2 cm below the EGJ Siewert Type III: Subcardial carcinoma with the tumor epicenter between 2 cm and 5 cm below the EGJ, which infiltrates the EGJ and lower esophagus from below. Siewert Type I and II tumors are normally treated as one would an esophageal cancer (or EGJ cancer). Siewert type III lesions are considered gastric cancers, and thus should be treated as described in the NCCN guidelines for Gastric cancer. For a patient with locoregional gastric cancer that is cT2 or higher (any N), there is category 1 evidence to offer perioperative chemotherapy. The preferred regimen is FLOT (5-FU, Leucovorin, Oxaliplatin, and Docetaxel). FOLFOX and 5-FU/Cisplatin are the other perioperative regimens that could be offered. Reference: https://www.nccn.org/professionals/ph...